1. VHA National Pain Management Strategy: Stepped care model implementation Robert D. Kerns, Ph.D. National Program Director Robert D. Kerns, Ph.D. National Program Director

2. Overview and objectives Agenda - Updates from VACO and Coordinating Committee - Gallagher – Pain Management Directive - Kerns – Performance measurement - Mariano – Primary Care Rural Health Initiative - Norton/Clark – Tampa Externship - Goodman – Opioid therapy: Practice and policy - Rashad – Nursing initiatives - Mariano – Patient education: MyHealtheVet - Implementation of the stepped pain care model - VISN presentations - Open discussion of barriers and facilitators Agenda - Updates from VACO and Coordinating Committee - Gallagher – Pain Management Directive - Kerns – Performance measurement - Mariano – Primary Care Rural Health Initiative - Norton/Clark – Tampa Externship - Goodman – Opioid therapy: Practice and policy - Rashad – Nursing initiatives - Mariano – Patient education: MyHealtheVet - Implementation of the stepped pain care model - VISN presentations - Open discussion of barriers and facilitators

4. Performance Metrics: Report to Congress HAIG Pain Management Survey HCAHPS - Patient Satisfaction Pain clinic MD staffing and workload Other possible measures HAIG Pain Management Survey HCAHPS - Patient Satisfaction Pain clinic MD staffing and workload Other possible measures

5. Health Analysis and Information Group (HAIG) Pain Management Survey TAG: Kerns, Cremo, Gallagher, Anderson, Nilan Single respondent per facility - Ideal respondent is Facility/HCS Pain POC Distribution on October 5 Content: - Adherence to Pain Management Directive - Organizational structure - Pain services and staffing - Opioid safety practices - Implementation of stepped care model - Staff education programs - Patient education programs TAG: Kerns, Cremo, Gallagher, Anderson, Nilan Single respondent per facility - Ideal respondent is Facility/HCS Pain POC Distribution on October 5 Content: - Adherence to Pain Management Directive - Organizational structure - Pain services and staffing - Opioid safety practices - Implementation of stepped care model - Staff education programs - Patient education programs

6. Patient satisfaction: HCAHPS* (Oct 08-May 09) National VISNs VAMCs Benchmark Score Min Max Min Max Composite 88.1 85.3 91.2 76.9 97.8 91 Q13 86.2 84.1 89 73.5 95.5 89 Q14 90 85.3 93.6 80.4 100 93 Q13: During this hospital stay, how often was your pain well controlled? Q14: During this hospital stay, how often did the hospital staff do everything they could to help you with your pain? Respondent N: 23,270 Percent of respondents designating “usually” or “always”. Adjusted for number of respondents in each sample http://vaww.oqp.med.va.gov/oqp_services/performance_measurement/shep.html * Consumer Assessment of Healthcare Providers and Systems National VISNs VAMCs Benchmark Score Min Max Min Max Composite 88.1 85.3 91.2 76.9 97.8 91 Q13 86.2 84.1 89 73.5 95.5 89 Q14 90 85.3 93.6 80.4 100 93 Q13: During this hospital stay, how often was your pain well controlled? Q14: During this hospital stay, how often did the hospital staff do everything they could to help you with your pain? Respondent N: 23,270 Percent of respondents designating “usually” or “always”. Adjusted for number of respondents in each sample http://vaww.oqp.med.va.gov/oqp_services/performance_measurement/shep.html * Consumer Assessment of Healthcare Providers and Systems

7. Pain clinic workload and MD staffing FY07FY08FY09 YTD Encounters48,26455,19048,805 Unique Pts20,86023,80623,824 MD FTE58.7865.4580.98 FY07FY08FY09 YTD Encounters48,26455,19048,805 Unique Pts20,86023,80623,824 MD FTE58.7865.4580.98

8. Other performance metrics Joint Commission survey results LMS/TEMPO provider education MyHealtheVet access Timeliness of pain clinic access Cancer quality indicators Opioid safety practices Joint Commission survey results LMS/TEMPO provider education MyHealtheVet access Timeliness of pain clinic access Cancer quality indicators Opioid safety practices